DGI Fact Finder

Primary Insured

Full Name:(Required)

First Last

Date of Birth:(Required)

Social Security Number

Phone(Required)

Email(Required)

Marital Status(Required)

Spouse Information

Spouse Full Name (if applicable):

First Last

Spouse Date of Birth (if applicable):

Spouse Social Security Number

New Address (if new purchase):

Street Address Address Line 2 City State ZIP Code

Closing Date:

Current Physical Address:

Street Address Address Line 2 City State ZIP Code

Is your mailing address the same as your physical address?

Mailing address:

Street Address Address Line 2 City State ZIP Code

Home Information

Owned Home Since:

Year Built:

Square Feet:

# of Stories:

Any active reporting alarms (i.e. ADT, Viviant Smart Home, ect.)?

Number of Bedrooms:

Number of Bathrooms:

Construction:

What is the siding (vinyl, hardboard, wood, etc)?

Roof:

Year that the roof was updated/replaced

Foundation:

Fireplace:

How many?

Free Standing Wood Burning Stove?

Central HVAC?

Gas or Electric Heat

Attached garage?

How many cars/bays:

If no attached garage, is there an attached carport? How many cars will it house?

Is there a detached garage?

How many cars will it house?

Do you have an above or in-ground pool?

Does the pool or the yard have a fence around it?

Is there a diving board or slide?

If there is a diving board or slide, how deep is the deepest end?

Is there a trampoline?

Does the trampoline have a net around it? Is it in a fenced in part of the yard?

Current Home Insurance Carrier

Home Updates

Year of last HVAC update

Year of last plumbing update

Year of last wiring/electrical update

Additional Home Information

Are there any wood decks, patios, or screened-in/enclosed porches?

If so, what is the square footage (of each, if have more than 1)?

Do you own any dogs?

If so, what breed(s)? Any biting or aggressive history?

Any children under 18?

If so, how many?

Auto Information

Primary Insured's Driver’s License Number:

Spouse driver’s license number:

Additional drivers in household

Name:

Date of birth:

Driver’s license number:

Vehicle(s)

Year

Make

Model

VIN

Driver

Are any of the vehicles used for business, rideshare (Uber, Lyft, etc.), or delivery (Amazon, DoorDash, etc.(Required)

Current Carrier:

Renewal Date:

Liability Limits

Type of Coverage

Do you want Umbrella quote?

Do you want a life quote?